Intensive Care Med DOI 10.1007/s00134-015-3940-9
Miguel A. Herna´ndez-Herna´ndez Jose´ L. Ferna´ndez-Torre Marı´a S. Holanda-Pen˜a Marta Cabello
IMAGING IN INTENSIVE CARE MEDICINE
Central venous catheter malposition into pulmonary vein: an unusual cause of epileptic seizures
A 64-year-old man was admitted to our intensive care unit with acute respiratory failure. A 60-cm femoral central venous catheter (CVC) was inserted to avoid Ó Springer-Verlag Berlin Heidelberg and ESICM 2015 laying the patient down. A right lower atelectasis was Electronic supplementary material The online version of this seen on a chest X-ray, but the position of the catheter tip was not correctly verified. Twenty-four hours later, article (doi:10.1007/s00134-015-3940-9) contains supplementary material, which is available to authorized users. he had a seizure. A brain computed tomography (CT) angiography was performed. Intravenous contrast was M. A. Herna´ndez-Herna´ndez ()) M. S. Holanda-Pen˜a Department of Intensive Medicine, University Hospital Marque´s de injected through the femoral catheter and appeared directly in the left atrium (LA) (Fig. 1a). A thoracic Valdecilla, Avda. Valdecilla n8 25, 39008 Santander, Cantabria, CT showed an anomalous bend of the CVC (Fig. 1b) Spain e-mail: [email protected] with the tip in the right lower pulmonary vein Tel.: ?34-942-202520 (Fig. 1c). Transesophageal echocardiography confirmed the entry of the catheter into the LA through J. L. Ferna´ndez-Torre the foramen ovale (Fig. 1d) with a thrombus attached Department of Clinical Neurophysiology, University Hospital to it and floating inside (Video 1). Anticoagulation ´ Marques de Valdecilla, Santander, Spain was started and a new CT scan showed an ischemic stroke. M. Cabello Department of Respiratory, University Hospital Marque´s de Catheter malposition is reported to occur in Valdecilla, Santander, Spain 10–30 %. CVC into the left side of the heart through the foramen ovale is an exceptional complication and M. A. Herna´ndez-Herna´ndez J. L. Ferna´ndez-Torre M. Cabello secondary cerebral thromboembolism has been Biomedical Research Institute (IDIVAL), Santander, Spain described only related to pacemaker lead misplacement. Catheter malposition should be suspected if J. L. Ferna´ndez-Torre neurological symptoms appear after insertion and Department of Physiology and Pharmacology, University of Received: 18 June 2015 Accepted: 18 June 2015
Cantabria (UNICAN), Santander, Cantabria, Spain
Fig. 1 a CT angiography with contrast evident in the left atrium (LA) immediately after intravenous injection. b 3D thoracic CT reconstruction revealing an anomalous bend of the catheter (arrows). c Oblique thoracic CT reconstruction showing the CVC crossing from the right atrium (RA) to the LA with the tip located in the right lower pulmonary vein (arrow). d Transesophageal echocardiography disclosing the catheter entry through the foramen ovale (arrow)
CVC tip position should be verified to avoid serious Conflicts of interest On behalf of all authors, the corresponding author states that there is no conflict of interest. events.
Miguel A. Herna´ndez-Herna´ndez Jose´ L. Ferna´ndez-Torre Marı´a S. Holanda-Pen˜a Marta Cabello
IMAGING IN INTENSIVE CARE MEDICINE
Central venous catheter malposition into pulmonary vein: an unusual cause of epileptic seizures
A 64-year-old man was admitted to our intensive care unit with acute respiratory failure. A 60-cm femoral central venous catheter (CVC) was inserted to avoid Ó Springer-Verlag Berlin Heidelberg and ESICM 2015 laying the patient down. A right lower atelectasis was Electronic supplementary material The online version of this seen on a chest X-ray, but the position of the catheter tip was not correctly verified. Twenty-four hours later, article (doi:10.1007/s00134-015-3940-9) contains supplementary material, which is available to authorized users. he had a seizure. A brain computed tomography (CT) angiography was performed. Intravenous contrast was M. A. Herna´ndez-Herna´ndez ()) M. S. Holanda-Pen˜a Department of Intensive Medicine, University Hospital Marque´s de injected through the femoral catheter and appeared directly in the left atrium (LA) (Fig. 1a). A thoracic Valdecilla, Avda. Valdecilla n8 25, 39008 Santander, Cantabria, CT showed an anomalous bend of the CVC (Fig. 1b) Spain e-mail: [email protected] with the tip in the right lower pulmonary vein Tel.: ?34-942-202520 (Fig. 1c). Transesophageal echocardiography confirmed the entry of the catheter into the LA through J. L. Ferna´ndez-Torre the foramen ovale (Fig. 1d) with a thrombus attached Department of Clinical Neurophysiology, University Hospital to it and floating inside (Video 1). Anticoagulation ´ Marques de Valdecilla, Santander, Spain was started and a new CT scan showed an ischemic stroke. M. Cabello Department of Respiratory, University Hospital Marque´s de Catheter malposition is reported to occur in Valdecilla, Santander, Spain 10–30 %. CVC into the left side of the heart through the foramen ovale is an exceptional complication and M. A. Herna´ndez-Herna´ndez J. L. Ferna´ndez-Torre M. Cabello secondary cerebral thromboembolism has been Biomedical Research Institute (IDIVAL), Santander, Spain described only related to pacemaker lead misplacement. Catheter malposition should be suspected if J. L. Ferna´ndez-Torre neurological symptoms appear after insertion and Department of Physiology and Pharmacology, University of Received: 18 June 2015 Accepted: 18 June 2015
Cantabria (UNICAN), Santander, Cantabria, Spain
Fig. 1 a CT angiography with contrast evident in the left atrium (LA) immediately after intravenous injection. b 3D thoracic CT reconstruction revealing an anomalous bend of the catheter (arrows). c Oblique thoracic CT reconstruction showing the CVC crossing from the right atrium (RA) to the LA with the tip located in the right lower pulmonary vein (arrow). d Transesophageal echocardiography disclosing the catheter entry through the foramen ovale (arrow)
CVC tip position should be verified to avoid serious Conflicts of interest On behalf of all authors, the corresponding author states that there is no conflict of interest. events.
